Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy
Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on...
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| Veröffentlicht in: | Diabetes care 2020-12, Vol.43 (12), p.3042-3049 |
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| creator | Mirani, Marco Favacchio, Giuseppe Carrone, Flaminia Betella, Nazarena Biamonte, Emilia Morenghi, Emanuela Mazziotti, Gherardo Lania, Andrea Gerardo |
| description | Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients.
This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality.
Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%,
< 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95;
= 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35;
= 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38;
= 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55;
= 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42;
= 0.04) but not with type 2 diabetes (
= 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L;
= 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase;
= 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95;
= 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60;
= 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92;
= 0.042).
Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes. |
| doi_str_mv | 10.2337/dc20-1340 |
| format | Article |
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This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality.
Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%,
< 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95;
= 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35;
= 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38;
= 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55;
= 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42;
= 0.04) but not with type 2 diabetes (
= 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L;
= 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase;
= 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95;
= 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60;
= 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92;
= 0.042).
Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc20-1340</identifier><identifier>PMID: 33023989</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Betacoronavirus ; Blood Glucose ; Cardiovascular disease ; Comorbidity ; Coronary artery ; Coronary artery disease ; Coronaviridae ; Coronavirus ; Coronavirus Infections ; Coronaviruses ; COVID-19 ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - epidemiology ; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use ; Glucose ; Health hazards ; Heart diseases ; Humans ; Hypertension ; Inhibitors ; Insulin ; Interleukin 6 ; Italy - epidemiology ; Kidney diseases ; Mortality ; Pandemics ; Patients ; Peptidase ; Peptidases ; Pneumonia, Viral ; Research design ; Respiratory diseases ; Risk analysis ; Risk Factors ; SARS-CoV-2 ; Severe acute respiratory syndrome ; Severe acute respiratory syndrome coronavirus 2 ; Sitagliptin Phosphate ; Survival ; Viral diseases</subject><ispartof>Diabetes care, 2020-12, Vol.43 (12), p.3042-3049</ispartof><rights>2020 by the American Diabetes Association.</rights><rights>Copyright American Diabetes Association Dec 1, 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-fa7b8013f1ee11661ef81eefb122af9256cfd35de20c71d75f3e2b6edd227efb3</citedby><cites>FETCH-LOGICAL-c353t-fa7b8013f1ee11661ef81eefb122af9256cfd35de20c71d75f3e2b6edd227efb3</cites><orcidid>0000-0002-4187-5378</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33023989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mirani, Marco</creatorcontrib><creatorcontrib>Favacchio, Giuseppe</creatorcontrib><creatorcontrib>Carrone, Flaminia</creatorcontrib><creatorcontrib>Betella, Nazarena</creatorcontrib><creatorcontrib>Biamonte, Emilia</creatorcontrib><creatorcontrib>Morenghi, Emanuela</creatorcontrib><creatorcontrib>Mazziotti, Gherardo</creatorcontrib><creatorcontrib>Lania, Andrea Gerardo</creatorcontrib><title>Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients.
This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality.
Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%,
< 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95;
= 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35;
= 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38;
= 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55;
= 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42;
= 0.04) but not with type 2 diabetes (
= 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L;
= 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase;
= 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95;
= 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60;
= 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92;
= 0.042).
Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.</description><subject>Betacoronavirus</subject><subject>Blood Glucose</subject><subject>Cardiovascular disease</subject><subject>Comorbidity</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Coronaviridae</subject><subject>Coronavirus</subject><subject>Coronavirus Infections</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</subject><subject>Glucose</subject><subject>Health hazards</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Inhibitors</subject><subject>Insulin</subject><subject>Interleukin 6</subject><subject>Italy - epidemiology</subject><subject>Kidney diseases</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Peptidase</subject><subject>Peptidases</subject><subject>Pneumonia, Viral</subject><subject>Research design</subject><subject>Respiratory diseases</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Sitagliptin Phosphate</subject><subject>Survival</subject><subject>Viral diseases</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxi0EotvCgRdAlrhQiYD_ZRNzW6W0jbRSK1HgGDn2WHWVxKntPeT1eDKcduGALzOa-fmb0XwIvaPkM-O8-mI0IwXlgrxAGyp5WZSlqF-iDaFCFqWU7ASdxvhACBGirl-jE84J47KWG_S7HWelE_YWN370oXfGJQcRq8ngq2HRMDqFVcI7M7oYnZ-eOhduhjk5swz49ilREbDA7XTvepd8iNhN-FZlpSlF_Mule3y3zIBZ_ql6SHAsNjc_24uCyq94h5tV4zuEdfpl8GMehHdambyBxtc-zi6pYdXd-7FXwSyfcJsryxv0yqohwttjPEM_Lr_dNdfF_uaqbXb7QvOSp8Kqqq8J5ZYCULrdUrB1Tm1PGVNWsnKrreGlAUZ0RU1VWg6s34IxjFUZ42fo47PuHPzjAWLq8kU0DIOawB9ix4SQtCa8ohn98B_64A9hyttlquKCy_wydf5M6eBjDGC7ObhRhaWjpFuN7VZju9XYzL4_Kh76Ecw_8q-T_A8DXp4f</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Mirani, Marco</creator><creator>Favacchio, Giuseppe</creator><creator>Carrone, Flaminia</creator><creator>Betella, Nazarena</creator><creator>Biamonte, Emilia</creator><creator>Morenghi, Emanuela</creator><creator>Mazziotti, Gherardo</creator><creator>Lania, Andrea Gerardo</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4187-5378</orcidid></search><sort><creationdate>202012</creationdate><title>Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy</title><author>Mirani, Marco ; Favacchio, Giuseppe ; Carrone, Flaminia ; Betella, Nazarena ; Biamonte, Emilia ; Morenghi, Emanuela ; Mazziotti, Gherardo ; Lania, Andrea Gerardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-fa7b8013f1ee11661ef81eefb122af9256cfd35de20c71d75f3e2b6edd227efb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Betacoronavirus</topic><topic>Blood Glucose</topic><topic>Cardiovascular disease</topic><topic>Comorbidity</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Coronaviridae</topic><topic>Coronavirus</topic><topic>Coronavirus Infections</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</topic><topic>Glucose</topic><topic>Health hazards</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Inhibitors</topic><topic>Insulin</topic><topic>Interleukin 6</topic><topic>Italy - epidemiology</topic><topic>Kidney diseases</topic><topic>Mortality</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Peptidase</topic><topic>Peptidases</topic><topic>Pneumonia, Viral</topic><topic>Research design</topic><topic>Respiratory diseases</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Sitagliptin Phosphate</topic><topic>Survival</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mirani, Marco</creatorcontrib><creatorcontrib>Favacchio, Giuseppe</creatorcontrib><creatorcontrib>Carrone, Flaminia</creatorcontrib><creatorcontrib>Betella, Nazarena</creatorcontrib><creatorcontrib>Biamonte, Emilia</creatorcontrib><creatorcontrib>Morenghi, Emanuela</creatorcontrib><creatorcontrib>Mazziotti, Gherardo</creatorcontrib><creatorcontrib>Lania, Andrea Gerardo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mirani, Marco</au><au>Favacchio, Giuseppe</au><au>Carrone, Flaminia</au><au>Betella, Nazarena</au><au>Biamonte, Emilia</au><au>Morenghi, Emanuela</au><au>Mazziotti, Gherardo</au><au>Lania, Andrea Gerardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2020-12</date><risdate>2020</risdate><volume>43</volume><issue>12</issue><spage>3042</spage><epage>3049</epage><pages>3042-3049</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients.
This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality.
Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%,
< 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95;
= 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35;
= 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38;
= 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55;
= 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42;
= 0.04) but not with type 2 diabetes (
= 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L;
= 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase;
= 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95;
= 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60;
= 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92;
= 0.042).
Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>33023989</pmid><doi>10.2337/dc20-1340</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4187-5378</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Diabetes care, 2020-12, Vol.43 (12), p.3042-3049 |
| issn | 0149-5992 1935-5548 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Betacoronavirus Blood Glucose Cardiovascular disease Comorbidity Coronary artery Coronary artery disease Coronaviridae Coronavirus Coronavirus Infections Coronaviruses COVID-19 Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - epidemiology Dipeptidyl-Peptidase IV Inhibitors - therapeutic use Glucose Health hazards Heart diseases Humans Hypertension Inhibitors Insulin Interleukin 6 Italy - epidemiology Kidney diseases Mortality Pandemics Patients Peptidase Peptidases Pneumonia, Viral Research design Respiratory diseases Risk analysis Risk Factors SARS-CoV-2 Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Sitagliptin Phosphate Survival Viral diseases |
| title | Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy |
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